Patient Guide for Dental Implant Surgery

Q: Why was my implant "buried" under the gums instead of having the metal button stick out?

We choose to bury an implant when the situation requires an extra layer of protection during the healing phase. Common reasons include: soft bone that requires undisturbed healing (low initial stability), the presence of a denture that could put pressure on the implant, or if a significant bone graft was performed at the same time.

Q: What is the second-stage surgery like to uncover the implant?

The purpose of the second-stage surgery is twofold: to expose the implant and, more importantly, to ensure there is a thick, strong “collar” of gum tissue around it for long-term health. The procedure will depend on the quality of your gums in that area. If you have sufficient, strong gum tissue, the procedure is very simple. We make a tiny opening in the gums (a “tissue punch”) and place the healing abutment. If you need stronger gum tissue, we will perform a minor soft tissue graft at the same time. This may involve repositioning the existing gum tissue (a “roll technique”) or adding a small piece of tissue from another area (a “free gingival graft”). We will always discuss the specific plan with you beforehand. If a graft is needed, the recovery is slightly more involved but is critical for the long-term success of your implant.`

Q: Can a dental implant get a cavity?

No, an implant cannot get a cavity. However, they are still susceptible to a form of gum disease called “peri-implantitis,” an infection that attacks the bone supporting the implant. This is why daily hygiene is absolutely critical for its long-term health.

Surgical Care Instructions

Pain Management

Your recovery depends on a precise medication schedule. It is essential that you follow the specific protocol prescribed for you, based on your unique health history.

Medication Plan:

Below is our standard protocol. If you have allergies or specific health conditions, we will have prescribed the appropriate evidence-based alternative for you.

1. Pain & Inflammation Control

Standard Protocol: Take 600mg of Ibuprofen AND 500mg of Tylenol (Acetaminophen) together, every 6 hours for the first 1-2 days, then as needed.
Important Contraindications: We will NOT prescribe Ibuprofen if you have kidney disease, a history of GI ulcers, or are on certain blood thinners. We will NOT prescribe Tylenol if you have liver disease. In these cases, we will have provided a safe alternative.

2. Antibiotics

Standard Protocol: Take one tablet of Amoxicillin (500mg) three times per day for the prescribed duration. You must finish the entire course.
For Penicillin Allergy: If you have a penicillin allergy, we will have prescribed a specific alternative to ensure your safety and prevent infection. Based on current clinical guidelines, this may include one of the following:
- Azithromycin (Z-Pak®)
- Doxycycline
- Clarithromycin
- For patients without a history of severe allergic reaction (anaphylaxis), an alternative like Cephalexin may be used.
Clindamycin is reserved for specific situations due to higher rates of adverse reactions. Please take only the specific antibiotic prescribed for you.

3. Medicated Oral Rinse

Begin gently rinsing with 15mL of your 0.12% Chlorhexidine Gluconate prescription, two times per day for 14 days. Do this after brushing your other teeth. Swish very gently for 30 seconds and let the rinse fall out of your mouth; do not spit forcefully.

Bleeding Control

Minor oozing of blood from the surgical site is normal for the first 24 hours.

Gauze: If you notice active bleeding, apply firm but gentle pressure to the area with a piece of moistened gauze for 30 minutes.
Avoid: Do not spit, use a straw, or smoke. Avoid vigorous rinsing, as this can disturb the healing site.

Swelling Management

For a simple, single implant, you should expect only minimal swelling.

Ice Packs: You may apply an ice pack to the outside of your face for 20 minutes on, 10 minutes off for the first day to help minimize any potential swelling.

Oral Hygiene/Site Care

The way your implant was placed determines your specific hygiene instructions. Please follow the instructions that match your situation. (If you are unsure, please call us!)

Note: If you had a bone graft (GBR) or gum graft (FGG) at the same time, please follow the instructions from those guides, as they are more detailed.

Scenario 1: Your Implant Has a Healing Abutment (One-Stage Surgery)

In most straightforward cases, especially with our use of surgical guides, we perform a minimally invasive “flapless” surgery and place a “healing abutment.” You will see a small, round metal button sitting just above your gums.

DO NOT chew directly on the healing abutment.
For the first week, clean the area by gently swishing with your prescribed medicated rinse (Chlorhexidine).
After one week, you can begin to very gently brush the top and sides of the metal healing abutment with a soft toothbrush to keep it free of plaque.

Scenario 2: Your Implant is “Buried” (Two-Stage Surgery)

In some situations, it is safer for the implant to be “buried” under the gums to heal. In this case, your gum tissue will be stitched together, and you will not see any part of the implant.

Simply keep the area clean by gently rinsing with your prescribed medicated rinse or warm salt water.
Do not brush the surgical site itself until we instruct you otherwise.
You will require a second, very minor procedure in 3-4 months to expose the implant and place the healing abutment.

Dietary Recommendations

Stick to a soft diet for the first several days.
Do not chew on the side of your mouth where the surgery was performed. Any pressure on the healing implant can compromise its integration with your bone.

Activity Restrictions

Avoid all strenuous physical activity, exercise, or heavy lifting for at least 3 days to prevent bleeding and throbbing at the surgical site.

When To Call Us/ Urgent Symptoms

Frequently Asked Questions

Why was my implant "buried" under the gums instead of having the metal button stick out?

What is the second-stage surgery like to uncover the implant?

Can a dental implant get a cavity?

What are the real reasons a dental implant might fail?

This is the most important question a patient can ask. While implants have a very high success rate, failures can happen, and they are best understood by looking at the different contributing factors.

1. Our Role: Surgical & Restorative Factors

The foundation of success is meticulous, “prosthetically driven” planning, where we design the final tooth first and use a 3D scan to place the implant in the perfect position to support it. A failure to do this can lead to:

Improper Angulation: Causing cosmetic issues or areas that are difficult to clean.
Food Traps: Leading to cavities on adjacent natural teeth.

Our commitment also extends to the components we use. We use only authentic, OEM (Original Equipment Manufacturer) components from the world’s most reputable implant companies. The type of connection is also key; modern conical connections have the lowest incidence of mechanical issues like screw loosening.

2. Your Role: Health and Habits (Known Risk Factors)

Your health and daily habits are a major factor in long-term success. Well-established risk factors include:

Smoking: The single biggest risk factor.
Uncontrolled Diabetes: An A1c level above 8 significantly impacts healing.
History of Periodontal Disease.
Severe Bruxism (Grinding).
Poor Oral Hygiene: Daily, meticulous cleaning is non-negotiable to prevent gum disease around the implant (peri-implantitis).

3. The “Unpredictables”: Biology and Emerging Science

Sometimes, even with perfect surgery and a healthy patient, an implant may not heal as expected. Reasons can include:

Previous Site History: If an implant is placed in an area that was previously grafted, the quality of that bone is an unknown variable. A site where a previous implant has failed also carries a higher risk.
Systemic Factors: Medical science is constantly evolving. Active research suggests that certain conditions or medications may influence bone healing in ways we are still working to fully understand. These can include Vitamin D deficiency and the long-term use of common medications like PPIs (for acid reflux) and SSRIs (for depression).

Our commitment to you is to have a completely transparent discussion about your specific situation, combining what is known from decades of research with the latest in clinical science to give you the most predictable and successful outcome possible.